Telemedicine and rural America

An NPR story from earlier this week highlights the benefits of telemedicine, or telehealth, for those in rural areas of the country:

Telehealth turned Jill Hill’s life around.

The 63-year-old lives on the edge of rural Grass Valley, an old mining town in the Sierra Nevada foothills of northern California. She was devastated after her husband Dennis passed away in the fall of 2014 after a long series of medical and financial setbacks.

“I was grief-stricken and my self-esteem was down,” Hill remembers. “I didn’t care about myself. I didn’t brush my hair. I was isolated. I just kind of locked myself in the bedroom.”

Hill says knew she needed therapy to deal with her deepening depression. But the main health center in her rural town had just two therapists. Hill was told she’d only be able to see a therapist once a month.

Then, Brandy Hartsgrove called to say Hill was eligible via MediCal (California’s version of Medicaid) for a program that could offer her 30-minute video counseling sessions twice a week. The sessions would be via a computer screen with a therapist who was hundreds of miles south, in San Diego.

Hartsgrove co-ordinates telehealth for the Chapa-de Indian Health Clinic, which is a 10-minute drive from Hills’s home. Hill would sit in a comfy chair facing a screen in a small private room, Hartsgrove explained, to see and talk with her counselor in an otherwise traditional therapy session.

Hill thought it sounded “a bit impersonal;” but was desperate for the counseling. She agreed to give it a try.

Though Hill initially had reservations about meeting with a therapist online, she says she’s been amazed by how helpful the sessions have been.

“She gives me assignments and works me really hard,” Hill says, “and I have grown so much — especially just in the last few months.”

There are those that are skeptical of the disruptive impact that telemedicine, or telehealth, initiatives will have on the health care system and health care delivery more generally. However, the way I see it is, in a world where we get so many services on demand, why not health care? I don’t think telemedicine is supposed to replace the traditional delivery methods. But there are many instances where telemedicine can supplement and assist traditional delivery to make receiving care more accessible and more affordable. It could also free up doctors time to treat more patients. 

Of course, one aspect of telemedicine is that most services require the internet, which may not be available for everyone in the country. The article talks about a recent survey conducted which found these results:  


Not everyone has access to the internet in rural areas but it is increasingly becoming a more convenient way for individuals to receive care. The article ends with this thought: 

But policies that regulate which telehealth services get paid for “lag way behind the technology,” Kwong says. Many policies are 10 to 15 years behind what the technology is able to do, she says.

For example, high-resolution photos can now be taken – and sent anywhere digitally — of skin conditions that many doctors say are better than “the naked eye looking at the condition,” she says. But the policies on the books of what Medicare, Medicaid and private insurers will pay for often means these services are not fully covered.

That’s unfortunate, Kwong says, especially for underserved communities where there is a shortage of specialists.

Changes are starting to be made in state, federal and private insurance policies, Kwong says. But it’s “slow going.”

Presumably, the laws Ms. Kwong is talking about are telemedicine “private payer parity laws” which mandate that insurers must reimburse a doctor visit or procedure which is performed via telemedicine at the same rate as if the procedure was performed in the traditional doctor’s office. In a previous research update, I explained why parity laws are antithetical to telemedicine’s benefits. Requiring equal pay disincentivizes telemedicine’s cost-effectiveness. Private actors should be the ones deciding payment rates and inclusion of the services in benefit plans. As with many innovations, telemedicine will thrive if we leave it to the market.

Jordan Roberts / Health Policy Analyst

Jordan joined the Locke Foundation in the summer of 2018 as Health Care Policy Analyst. He analyzes state and national health policy issues with an eye toward removing governm...

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